The ENT Management of Acute Frontal Sinusitis With Intracranial Complications in Adult Patients

OBJECTIVES: To describe how adult patients with suppurative intracranial complications of acute frontal sinusitis have been managed across three neurosurgical centers in the northwest of England, United Kingdom. METHODS: A retrospective analysis over a 5-year period investigating adult patients (> 18 years old) presenting with acute frontal sinusitis with intracranial complications. RESULTS: Forty two patients were identified. 76.2% were male with a mean age of 43.1 years. The most common presenting complaint was headache. Subdural collection was the most common intracranial complication. The methods of operative management varied across the cohort. There was a high rate of revision surgery (41.5%) and a significant proportion of patients developed ongoing physical (38.5%) and neurocognitive (17.9%) sequelae. Patients undergoing neurosurgical treatment alone had a higher rate of ongoing physical sequelae (p = 0.0167). Further subgroup analysis found that the type of ENT intervention performed did not impact patient outcomes. The mortality rate was 7.1% across the study. CONCLUSION: To our knowledge, this is the largest multicenter study in adult patients only. Intracranial complications of frontal sinusitis are associated with significant morbidity and mortality and should be managed collaboratively between specialties. Further prospective studies are required to guide the optimal ENT intervention in this patient cohort.